The experience of general nurses in rural Australian emergency departments.

Australia is a geographically unique country with large areas classed as rural. Nurses providing emergency care in rural hospitals face a number of challenges, with rural communities expecting multi-skilled nurses, prepared for a wide range of unannounced situations. Using a mixed method approach, involving questionnaires and focus groups, the study was undertaken in two rural health services in Victoria, Australia. The aim was to explore the experiences of general nurses working in rural hospital settings, with regards to their emergency department responsibilities. The findings indicate that nurses lacked confidence, which they attributed to the sporadic nature of working in the area and the diversity of people who presented. A resultant 'skills rusting' was described and nurses identified the need to be a diverse 'specialist'. Some lack of confidence, particularly in the mental health area, was related to feelings of isolation and lack of context specific education and training. While some excellent emergency specific education and training is available for rural nurses, access is limited by a multitude of constraints. This study found there is an urgent need for local emergency education and training; with nurses showing a strong preference for ongoing professional development incorporating scenario based and context specific education.

Models of nursing student employment: an Australian action research study.

Over the last few years, Australian interest in the part time employment status of nursing students has increased. International models of paid employment, that target undergraduate students to work in a specific student nurse capacity, have attracted interest. The aim of this action research study was to consider nursing student employment models and develop recommendations that could be used to guide future policy and planning. An expert group was convened and used the cyclic process of planning, action, observation, evaluation and reflection to explore the issue. Through the process, the benefits and pitfalls of innovative, employment models were explored and resulted in consideration of whether there is potential for these models to provide a small push of the pendulum to a point where theory and practice are more closely aligned.

Mature age students access, entry and success in nurse education: an action research study.

This action research study involved an 'expert group' that was convened to consider issues for mature age nursing students in the Australian context and develop recommendations that could be used to strengthen mature age entry, access and success in nursing programs. Consistent with action research, the group worked through phases of planning, action, observation, evaluation and critical reflection. In developing recommendations that could be used for future planning, the group met regularly, reviewed extensive literature, and conducted two data collection activities, a questionnaire and focus group with education providers. From the action research activities, five major recommendations were generated. These focused on the value of mature age students, the need for specific information, transparent and clear processes for students entering nurse education, study support and finally, the provision of financial assistance.

Recognition and communication of patient deterioration in a regional hospital: a multi-methods study.

OBJECTIVE: In this study we aimed to identify the cues that ward nurses and doctors use to identify patient deterioration and, secondly, examine the assessment and communication of deterioration in patients on acute wards of a regional hospital. METHODS: Mixed methods case study design in a 220 bed regional hospital. Case studies originated from patients admitted unexpectedly to ICU from general wards (n=17). Data collection occurred within 72 h of the patient's admission to ICU. Interviews with 11 nurses and 14 doctors, and chart audit of 17 patient records for the 24 h prior to ICU were undertaken. RESULTS: The results demonstrate reliance on vital signs for nurses and doctors for initial identification of patient deterioration. Subsequent to this, nurses relied on assessment of the patient's physical capabilities whilst doctors undertook additional clinical investigations. Admission category and co-morbidities increased clinicians' identification of deterioration but the extent of assessment was dictated by 'usual practice' for the regional hospital, the ward or particular patient category. A lack of timely referral to more senior clinicians was identified. Chart audit found that 13 (76%) patients had clinical markers prior to ICU admission and 10 (56%) had these markers for >2h in the previous 24h. CONCLUSIONS: This study highlights inadequate communication between clinicians and lack of process for ensuring timely management when patients deteriorate in a regional hospital. The use of casual or locum staff who are less familiar with the clinical culture of regional hospitals may influence the recognition of, and response to, deteriorating ward patients.

Review of effective advanced cardiac life support training using experiential learning.

AIMS AND OBJECTIVES: This paper examines issues of contention regarding current practices and suggests the application of the experiential theory of learning (incorporating reflective practice) to advanced cardiac life support (ACLS) training. BACKGROUND: The need for formalized training in cardiopulmonary resuscitation (CPR) and ACLS is well documented. However, the effectiveness of traditional training programmes has not been firmly established. The question still remains - how to best ensure transfer of learning enabling learners to apply classroom knowledge successfully in the clinical setting. It is argued that educators can no longer rely on traditional teaching methods and more effective learner-centred education techniques are required. METHOD: A review of available literature regarding ACLS training has been conducted for this discussion. DATA SOURCES AND SELECTION: MEDLINE, CINAHL, OVID, Expanded Academic and Proquest were searched using textwords. English-language articles related to CPR and ACLS practices and also experiential learning were reviewed. Additional references were also reviewed from the bibliographies and from citation searches on key articles. Articles related to CPR/ACLS and experiential learning practices published within the last 10 years were reviewed. RESULTS: There is evidence that past ACLS training programmes have proven inconsistent and inadequate, with numerous studies reporting trainees have poor retention; and, therefore, ineffective ACLS skills as a result. CONCLUSIONS: The reviewed literature demonstrates that the need for effective ACLS training is clear. Increasing numbers of critically ill patients in hospitals means that it has never been more important to ensure the competence of healthcare professionals. Training must give learners a chance to pull together all aspects of ACLS and the use of experiential learning has the potential to achieve this aim. RELEVANCE TO CLINICAL PRACTICE: It is argued that providing training designed and implemented using experimental learning enhances learning through critical thinking and reflection, and subsequently should improve ACLS outcomes.